부산대학교 도서관

Highlights * Management of asymptomatic primary hyperparathyroidism in patients age >50 is controversial. * Age >50 more frequently underwent bilateral neck exploration and had multigland disease. * There was no difference between age groups and parathyroidectomy-related complications. Abstract Background Management of asymptomatic primary hyperparathyroidism (PHPT) in older patients (age >50) is controversial. The 4th International Workshop on the Management of Asymptomatic PHPT recommends surveillance for older patients who lack objective signs of disease, whereas The American Association of Endocrine Surgeons (AAES) guidelines recommend consideration of parathyroidectomy for patients of any age with subjective constitutional, neuropsychiatric, or cognitive symptoms. Therefore, the primary objective of this study was to evaluate the association between patient age and both practice patterns and outcomes in the management of patients with sporadic PHPT. Methods The Collaborative Endocrine Surgery Quality Improvement Program (CESQIP) database was queried for all adults (age [greater than or equal to]18) who underwent an index parathyroidectomy for sporadic primary hyperparathyroidism between 2014 and 2020. Associations between patient age ([less than or equal to]50 years vs. >50 years) and both practice patterns and outcomes were evaluated separately using adjusted multivariable logistic and multinomial regression models. Results Of 9,938 patients who underwent parathyroidectomy, 8,080 (81.3%) were >50 years old and 1,858 (18.7%) were [less than or equal to]50. Of this cohort, 17% of older patients and 26% of younger patients presented with only subjective symptoms. Compared to younger patients, older patients were more likely to have an objective indication for parathyroidectomy (aOR = 1.8, 95%CI: 1.6--2.0, p < 0.001). They were also more likely to undergo [greater than or equal to]2 imaging studies pre-operatively (aOR = 1.2, 95%CI: 1.1--1.3, p = 0.003), to undergo bilateral neck exploration (aOR = 1.4, 95%CI: 1.3--1.6, p < 0.001), and to have multi-gland disease (aOR = 1.6, 95%CI: 1.4--1.8, p < 0.001). There was no difference between age groups and parathyroidectomy-related complications including hypocalcemia, vocal cord dysfunction, hematoma requiring evacuation, or reintubation, however, older patients were less likely to have any peri-operative morbidity (aOR = 0.7, 95%CI: 0.6--0.9, p = 0.011). Conclusions Older patients were more likely to meet objective criteria prior to undergoing parathyroidectomy by CESQIP participating high-volume endocrine surgeons, however they were less likely to have peri-operative complications compared to younger patients. Given the growing evidence demonstrating improvement of both objective and subjective symptoms after parathyroidectomy for PHPT, additional studies are still needed to fully understand the benefit of surgical referral in older adults for less objective indications. Author Affiliation: (a) Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA (b) Department of Surgery, University of Nebraska Medical Center, Omaha, NE, 68198, USA * Corresponding author. Department of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 606, Baltimore, MD, 21287, USA. Article History: Received 24 November 2021; Revised 4 February 2022; Accepted 1 March 2022 Byline: Whitney Sutton (a), Joseph K. Canner (a), Jessica B. Shank (b), Abbey L. Fingeret (b), Shkala Karzai (a), Dorry L. Segev (a), Jason D. Prescott (a), Aarti Mathur [Amathu10@jhmi.edu] (a,*)